Aspirin was first widely used as a painkiller in clinical practice, but later it was found that aspirin could inhibit platelet aggregation and prevent thrombosis, and now it is more often used in the prevention and treatment of cardiovascular diseases. However, there are obvious misunderstandings in the application of aspirin, and we often encounter the strange phenomenon of not using what should be used and not using what should be used indiscriminately in clinical practice. Aspirin is not without side effects, can lead to gastrointestinal bleeding and brain bleeding, the indiscriminate use of aspirin is harmful.
1, who must use aspirin?
People who have had an angiogram to confirm a diagnosis of coronary heart disease, myocardial infarction, stroke, peripheral vascular disease, stents and heart bypass surgery have been diagnosed with cardiovascular disease should take aspirin if it is not contraindicated. It is the responsibility of every physician to get all patients with cardiovascular disease who do not have a contraindication to aspirin to take aspirin. It is important to emphasize here that coronary heart disease is diagnosed by a cardiovascular specialist, not because of electrocardiograms or premature beats, atrial fibrillation and other conditions buckled on the coronary heart disease.
2.How long do I need to take aspirin?
All patients who meet the indications for taking aspirin and who do not have side effects such as gastrointestinal bleeding or asthma attacks while taking it, need to take it for a long time as long as they can tolerate it.
3.Should aspirin be taken in the morning or in the evening?
On this issue there is no definitive controversy, there is in the end is the evening or morning dosing each of the word. Some people believe that taking aspirin at night is more effective based on the fact that platelets are more active between 2:00 p.m. and 10:00 a.m., which is also a time of high incidence of cardiovascular disease. Some studies have also found that taking it in the morning with higher blood levels of prostacyclin at night is more effective in preventing nighttime cardiovascular attacks, suggesting that it should be taken in the morning. In fact, it does not matter what time of day you take the medication, as long as you take aspirin consistently over time to obtain a sustained platelet inhibitory effect. The current consensus among experts is that the effect of long-term aspirin use is continuous, and there is little difference between morning and evening, the key is to persist.
4.Should aspirin enteric tablets be taken on an empty stomach or after a meal?
Aspirin used to disintegrate in the stomach under the action of acidic gastric juice, causing gastrointestinal irritation and even gastric mucosal damage and bleeding, which is a common side effect of aspirin, and taking it after meals can reduce the side effects. At present, enteric aspirin is coated with an acid-resistant coating to protect it from being dissolved in the acidic environment of the stomach and slowly released and absorbed in the alkaline environment of the small intestine to reduce adverse gastrointestinal reactions. If taken during or after a meal, aspirin will mix with alkaline substances in food to prolong the residence time in the stomach and release the aspirin drug will produce gastrointestinal side effects. It is recommended that aspirin enteric tablets should be taken on an empty stomach to shorten the residence time in the stomach and reach the absorption site in the small intestine. But the prerequisite is to use enteric coated enteric aspirin tablets, which are more advantageous to import.
5.What is the best dose of aspirin?
The optimal dose of aspirin is 75-150 mg. In clinical practice, it is often encountered that some people worry about the side effects and take one or two aspirin enteric coated tablets (25 mg/tablet), which cannot achieve therapeutic and preventive effects. More than 150 mg cannot increase the efficacy, but only increase the side effects. At present, imported aspirin 100 mg per tablet, one tablet a day is enough, and domestic 25 mg aspirin 3 or 4 tablets (taken at once).
6.Who is prone to gastrointestinal bleeding after taking aspirin?
Aspirin is a double-edged sword. Aspirin can act directly on the gastric mucosa, destroying the protective barrier of the gastric mucosa, promoting the release of leukotrienes and other cytotoxic substances, and damaging the gastric mucosa; it can also damage the intestinal mucosal barrier. The inhibition of cyclooxygenase after absorption into the blood leads to a decrease in the synthesis of prostaglandins, which have a protective effect on the gastric mucosa, leading to damage and irritation of the gastrointestinal tract, which can seriously cause gastrointestinal bleeding. People with the following conditions are more likely to develop gastrointestinal damage and bleeding and should pay more attention to them: elderly people over 65 years old, history of peptic ulcer or bleeding, H. pylori infection, smoking and alcohol consumption, taking non-steroidal painkillers or glucocorticoids, combination of multiple antiplatelet or anticoagulant drugs, combination of spironolactone or antidepressants. Early consultation should be made once progressive anemia or dark stools are detected. Long-term aspirin is best to check stool occult blood every 3 months at the hospital to detect bleeding early.
7.How to take aspirin for patients who have had stents?
In clinical practice, we often encounter patients who have had stents for coronary artery disease taking double antiplatelet drugs for 12 months and then stop taking aspirin and take clopidogrel. This is incorrect, and current studies confirm that clopidogrel is not a substitute for aspirin for secondary prevention. The correct approach is to stop clopidogrel and take aspirin alone after 12 months of taking the dual antiplatelet drug aspirin and clopidogrel. If the patient cannot tolerate aspirin or is allergic to aspirin, clopidogrel can be used as a substitute for aspirin.
8.Who should not take aspirin?
Aspirin is a medicine there must be contraindications, if you can have a history of aspirin allergy, aspirin asthma, ongoing gastrointestinal bleeding and peptic ulcer requiring treatment, and intracranial hemorrhage in the past 6 weeks, do not take aspirin.
9.Can aspirin be stopped?
Inhibition of platelets by aspirin to exert antithrombotic effects can also lead to bleeding. When patients taking aspirin undergo surgery, it will be more difficult to stop bleeding. Surgeons often ask to stop aspirin, but in patients who have had a stent, stopping aspirin increases the risk of stent thrombosis, which is often fatal when it occurs. Therefore, when stopping antiplatelet drugs such as aspirin and clopidogrel, be sure to seek the advice of a cardiologist.
10.Can I take aspirin to prevent cancer?
There are quite a few studies on the findings that aspirin can reduce the incidence of esophageal cancer, colon cancer and breast cancer. However, considering the side effects of aspirin, there is a lack of effective evaluation on the net benefit. This means that the evidence for cancer prevention with aspirin is insufficient, and there are no national or international guidelines recommending aspirin for cancer prevention.
For patients with cerebral hemorrhage due to long-term aspirin use, ultra-early surgery may increase the risk of rebleeding. In units with conditions, the perioperative period can be chosen to improve coagulation function with reasonable application of fresh platelets and cold precipitation to reduce the risk of rebleeding.
11.Can I take aspirin again after brain hemorrhage?
This is the question of many patients and even doctors. Many scholars believe that aspirin can not only reduce the chance of cardiovascular and cerebrovascular ischemic events, but also reduce the risk of cerebral hemorrhage. It may seem contradictory to prevent ischemia and reduce bleeding at the same time, but in fact, it is not. Aspirin has a therapeutic effect of protecting vascular endothelium and anti-atherosclerosis on the basis of anti-platelet aggregation, so the application of aspirin can reduce cerebral bleeding. Of course, the application of aspirin should be based on the premise that the cerebral hemorrhage is completely controlled and other bleeding factors (such as hypertension and abnormal coagulation system function) are effectively relieved, and the dosage and application time should be reasonably selected based on the comprehensive systemic systemic condition.